One of the commonly cited concerns over closing schools during a pandemic has been the assertion that students would simply find other places to congregate, such as the mall.
Gains in reducing transmission of the virus due to `social distancing’, many have felt, were over-estimated due to non-compliance to advice to stay home.
We’ve a study today that appears in PLoS One, which looks at the self-reported behavior of students at private girls' school in Boston that closed for a week towards the end of the school year.
Grades 9-12 and grades 5-8 were sampled. This was a small study, and subject to a number of limitations (which are enumerated in the article).
Also, the severity of novel H1N1 wasn’t generally perceived by the public as a `deadly flu’. Behaviors observed during this last pandemic may not accurately reflect behavior in future, potentially more virulent, outbreaks.
That said, here is the abstract, followed by a couple of excerpts from the discussion area of the study.
The results, as you will see, are a mixed bag.
Social contacts continued, albeit at a lower level, once schools closed and disturbingly, many students failed to follow the advice to stay home if sick in the days leading up to the school’s closure.
Joel C. Miller, Leon Danon, Justin J. O'Hagan, Edward Goldstein, Martin Lajous, Marc Lipsitch
Many schools were temporarily closed in response to outbreaks of the recently emerged pandemic influenza A/H1N1 virus. The effectiveness of closing schools to reduce transmission depends largely on student/family behavior during the closure. We sought to improve our understanding of these behaviors.
To characterize this behavior, we surveyed students in grades 9–12 and parents of students in grades 5–8 about student activities during a weeklong closure of a school during the first months after the disease emerged. We found significant interaction with the community and other students–though less interaction with other students than during school–with the level of interaction increasing with grade.
Our results are useful for the future design of social distancing policies and to improving the ability of modeling studies to accurately predict their impact.
Surprisingly, interaction with other students was lower at the end of the closure than at the beginning, particularly in grades 9–11. We had anticipated that there would be an initial period of fear-based isolation followed by increased contacts as complacency grew. An explanation for the actual observations could be that families were initially unprepared for the closure and students had little to do except visit friends, but as the week progressed families planned additional activities. Alternately, the low level of contacts could represent studying at home for exams that occurred soon after returning to school.
The data suggest students did not closely adhere to advice from the school about behavior to control the spread of infection. Prior to the closure, students were advised to remain home for one week following onset of fever with respiratory symptoms. This was not followed, and some students attended school the day after symptom onset.
During the closure, students were advised to avoid contacts with other students and with the community, but our surveys show that they remained active, unless they became symptomatic. Whether it is important for apparently healthy students to avoid social contact for the entire closure is unclear: although direct evidence for or against significant presymptomatic transmission of influenza is weak , it is frequently assumed that a significant fraction of infections happen in the presymptomatic stage .